COPD

Question 1

What is bronchitis?

Answer 1

Inflammation of the lining of the bronchiole which narrows the airway

Question 2

What is emphysema?

Answer 2

When the smaller alveoli collapse into larger air sacs

Question 3

Is COPD fully reversible?

Answer 3

No

Question 4

What are the main respiratory symptoms of COPD?

Answer 4

Breathlessness, cough and recurrent chest infection

Question 5

What is the main cause of COPD?

Answer 5

Smoking

Question 6

What non-respiratory systems are also associated with COPD?

Answer 6

Loss of muscle mass, weight loss, cardiac disease and depression/anxiety

Question 7

What factors would make you suspect that a patient might have a COPD?

Answer 7

Age - over 35yrs, current or former smokers, chronic cough, breathlessness, sputum production, recurrent ‘winter’ bronchitis and wheeze or chest tightness

Question 8

If a patient has nocturnal symptoms and conditions such as eczema or allergic rhinitis, is it more likely to be COPD or asthma?

Answer 8

Asthma

Question 9

On examination what sort of signs might you see if the patient has a COPD?

Answer 9

Reduced chest expansion, prolonged expiration/wheeze, hyper inflated chest and possibly signs of respiratory failure

Question 10

What are the signs of respiratory failure?

Answer 10

Tachypneoa (rapid breathing), Cyanosis (blue skin or lips), use of accessory muscles, pursed lip breathing and peripheral oedema

Question 11

Why is spirometry used in when a COPD is suspected?

Answer 11

It can show an air obstruction which leads to a diagnosis and also determines the severity

Question 12

Why is an ECG sometimes done in those with COPD?

Answer 12

To look for any cardiac compromise and heart failure

Question 13

What non-pharmacological methods are used for the COPD management?

Answer 13

Smoking cessation, vaccinations, pulmonary rehabilitation, nutritional assessment and psychological support

Question 14

What are the benefits of pharmacological management of COPD?

Answer 14

Relief of symptoms, prevention of exacerbations and improved quality of life

Question 15

What different types of inhaled therapy are people with COPD given?

Answer 15

Short acting bronchodilators - SABA and SAMA
Long acting bronchodilators - LAMA or LABA
High dose inhaled corticosteroids (ICS) and LABA

Question 16

At what point would a patient with COPD be put on long term oxygen?

Answer 16

If the arterial partial pressure drops below 7.3kPa or is between 7.3 - 8 kPa but the patient has nocturnal hypoxia, polycythaemia, pulmonary hypertension or peripheral oedema etc.

Question 17

What symptoms would suggest an exacerbation of the COPD?

Answer 17

Increasing breathlessness, cough, increase in volume/purulence of sputum, wheeze and chest tightness

Question 18

How would an acute exacerbation of COPD (AECOPD) be managed?

Answer 18

• Short acting bronchodilators (nebulisers if need be)
• Steroids - prednisolone
• Antibiotics - if signs of infection
• Hospital admission if unwell - tachypneoa, low oxygen sats (less than 90%), hypotension etc.

Question 19

What investigations might be done if a patient is admitted to hospital with an acute exacerbation of their COPD?

Answer 19

• Full blood count –Biochemistry
• Glucose
• Theophylline conc.
• ABGs
• ECG
• Blood cultures
• Sputum microscopy, culture and sensitivity

Question 20

Besides smoking, what causes COPD?

Answer 20

• Chronic asthma,
• Passive smoking
• Maternal smoking
• Air pollution
• Occupation

Question 21

What is meant by 1 pack year?

Answer 21

1 pack of cigarettes every day for a year

Question 22

What would you expect to see on a chest radiograph of a patient with emphysema?

Answer 22

Hyperinflated lung fields (>10 ribs posteriorly), flattened diaphragms, lucent lung fields and bullae

Question 23

Name the investigations used to diagnose COPD

Answer 23

• Spirometry
• CXR
• ECG
• FBC
• BMI
• AIAT (if under fifty years)

Question 24

Name the complications of COPD

Answer 24

• Acute exacerbation
• Pneumonia
• Macro-nutrient deficiency
• Wasting
• Muscle Atrophy
• Polycythemia
• Pulmonary hypertension
• Cor pulmonale
• Depression
• Pneumothorax

Question 25

How would an acute exacerbation of COPD be managed on the wards?

Answer 25

• Target sats of 88-92%
• Nebulised bronchodilators
• Corticosteroids
• Antibiotics
• Assessing for evidence of respiratory failure

Question 26

Name the causes of COPD not attributed to smokin

Answer 26

• Chronic asthma
• Passive smoking
• Maternal smoking
• Air pollution
• Occupation

Question 27

What is the function of a1-antitrypsin?

Answer 27

It neutralises enzymes released by neutrophils

Question 28

List the potential differentials for COPD

Answer 28

• Asthma
• Lung cancer
• Left ventricular failure
• Fibrosing alveolitis
• Bronchiectasis
• Rare: TB and recurrent pulmonary emboli

Question 29

What features on a CXR would suggest COPD

Answer 29

• Hyperinflated lung fields (>10 posterior ribs)
• Flattened diaphragms
• Lucent lung fields
• Bullae

Question 30

What would an FBC show in a patient with COPD?

Answer 30

Secondary polycythaemia

Question 31

What might an ECG show in a patient with COPD?

Answer 31

• Right axis deviation
• P pulmonale
• T wave inversion V1-4

Question 32

List the clinical features of an acute exacerbation of COPD

Answer 32

• Increased cough and sputum
• Increased SOB
• Wheeze
• Oedema
• Confusion
• Drowsiness
• Cyanosis
• Flapping tremor
• Pyrexia

Question 33

Which investigations would you order for an acute exacerbation of COPD

Answer 33

• CXR
• Blood gases
• FBC
• U&Es
• Sputum culture

Question 34

How can an acute exacerbation of COPD be managed

Answer 34

• Nebulised bronchodilator B2 and anti-muscarinic
• O2
• Oral/IV corticosteroid
• Antibiotics
• Diuretics
• IV aminophylline
• Respiratory stimulant
• NIV